Discrepancies between Perceptions by Physicians and Nursing Staff of Intensive Care Unit End-of-Life Decisions

Authors:
  • FLFrançois Lemaire
    François Lemaire
  • BRBernard Regnier
    Bernard Regnier
  • KKKhaldoun Kuteifan
    Khaldoun Kuteifan
  • MBMichel Badet
    Michel Badet
  • PAPierre Asfar
    Pierre Asfar
  • SJSamir Jaber
    Samir Jaber
  • JCJean-Luc Chagnon
    Jean-Luc Chagnon
  • ARAnne Renault
    Anne Renault
  • RRRené Robert
    René Robert
  • FPFrédéric Pochard
    Frédéric Pochard
  • CHChristian Herve
    Christian Herve
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Abstract
Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.

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